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Apr 27 2016 10:06AM HP FaxFlag Cite chevron 2093341873 page <br /> UNDERGROUND STORAGE TANK SYSTEM APR 2 7 2016 <br /> DESIGNATED OPERATOR FACMITY EMPLOYEE TRAINING A RD <br /> For use by Unidocs AfemberAgenefes or where approved by your Local.Jurisdiction S iiy ��)r\I, <br /> Authority Cited. Title 2j, Div. 3, Ch. 15 California Code of ftegulafions(CCR) <br /> Facility Name: ` r"' o <br /> Facility Site Address: �.t C ut T�[- w City: i.', `J- <br /> Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground Storage Tank Operators <br /> provide training to facility employees who have responsibilities associated with the operation and/or maintenance of <br /> underground storage tank (UST) systems. The initial training must be provided within 30 days of the elate of hire. This <br /> training must be provided every 12 months. At least one of the facility employees present during operating hours must have <br /> current traiaing. This training fnust include, but is not limited to, the following items as specified in 23 CCR Sections <br /> 27I5(f)(1)and(2): <br /> 9 Operation of the UST system in a manner consistent with the facility's Best Management Practices; <br /> R The employee's role with regard to UST monitoring equipment as specified in the written UST Monitoring Plan; <br /> 12 The employee's role with regard to spills and oveThlls as specified in the written UST Response Plan; <br /> B Name(s)of contact person(s)for emergencies and monitoring equipment aiarrns, <br /> 23 CCR§2715(f)(3)requires that a list of employees who have been trained by the Designated Underground Storage Tank <br /> Operator(s)be maintained on-site,or off-site at a readily-available location if approved_by,the local aQencv and provided to <br /> the local agency upon request.Completion of this form will satisfy UST training record keeping requirements.71'be following <br /> employees have been trained as required by 23 CCR Sections 2715(f)(1)and(2): <br /> Facility Employee Name Trainin Date Hire Date Trainer Name <br /> � ✓s <br /> 1 , <br /> 1lL'J«rnT ��2 r 7_ <br /> via 01"Lls <br /> I <br /> f <br /> (ContMued on reverse) <br /> t?v Oli1-Ira www.a&dms.org 07/13/05 <br />